General News and Information

PacificSource Promotes Colorectal Cancer Screenings

To help raise awareness of colorectal cancer and the importance of getting a colonoscopy, PacificSource recently launched a series of short educational videos on the topic. The first video in the series features our Medical Director, Dr. Justin Montoya, offering a brief overview of colorectal cancer. Subsequent videos feature emotional interviews with several PacificSource staff who have lost a loved one to the disease, and their encouragement to viewers to schedule a colonoscopy or talk with their doctor about screening alternatives.

Check Member Eligibility and More, Via InTouch

PacificSource InTouch for Providers is a secure providers-only area of our website that lets you access information about your PacificSource patients and their claims 24 hours a day. To quickly find a patient’s eligibility and benefits through InTouch, select the “Check Benefits” button on the home page.

You can also use InTouch to submit claims electronically, check on the status of submitted claims and view claim details; check authorization status or submit new requests; view EOPs, create patient data reports, and more.

Registration for InTouch is easy. The site is available through the Web portal OneHealthPort. Visit PacificSource.com/providers to get started.

If you have questions about InTouch or would like to schedule a personalized training, your Provider Service Representative will be happy to help.

We’re proud to announce that Oregon Governor Kate Brown has appointed Kristen Dillon, M.D., to the Oregon Health Authority’s (OHA) Health Plan Quality Metrics Committee. Dillon currently serves as PacificSource’s Director of the Columbia Gorge Coordinated Care Organization and as Associate Medical Director (Medicaid). The committee, authorized by Senate Bill 440, has been created to align quality measures for multiple types of health plans over which OHA has authority.

Commercial News

Member ID Cards: Essential Info at Your Fingertips

Did you know PacificSource member ID cards contain key information you need for billing?

The front of the card includes the group name and number in the upper right. The letter in the group name lets you easily identify your patients’ PacificSource plan type:

G = Group

N = Individual and family

GE = Group exchange (purchased through the Health Insurance Marketplace)

NE = Individual and family exchange (Marketplace)

On the front of the card, you’ll also find the network name just below the member number. Also, if applicable, you’ll see the words “Referral Required” there. The back of the card includes relevant contact information as well as instructions and information about the member’s out-of-area network.

Oregon Prescription Drug Monitoring

Oregon’s Prescription Drug Monitoring Program (PDMP) is an easy tool that prescribers, pharmacists, and their delegates can use to prevent prescription drug abuse, dangerous co-prescribing, addiction and diversion, as well an opportunity to review individual prescribing patterns. PDMP is a statewide electronic database that stores a three-year history of a patient’s schedule II-IV controlled substance fill history in Oregon.

Billing Reminder: Submit Claims for All Services Rendered

Please remember to submit claims for all services rendered. This includes claims for noncovered services and zero or low-dollar billed amounts. Always bill with at least $.01 on all claim lines. If you have any questions regarding this, please reach out to your Provider Service Representative.

Medicaid

Billing and Reimbursement for SBIRT

Screening, Brief Intervention, Referral to Treatment (SBIRT), as you may know, is an approach to screening and early intervention for people experiencing or at risk for substance use disorders.

January 1, 2017, brought a change to the billing and coding of SBIRTs that are shorter than 15 minutes. CPT 99420 has been deleted from the CPT code book and replaced with CPT 96160. Oregon Health Plan’s reimbursement of this new code remains the same at zero dollars. However, the SBIRT measure has previously been one of the CCO’s Quality Incentive Measure goals and in 2018 will become an EHR based measure.

The CPT Codes 99408 and 99409 are also still acceptable when billing for an SBIRT with a Brief Intervention that is longer than 15 minutes. Each of these codes will still need to be paired with either diagnosis codes Z13.89 or Z13.9 based on medical documentation.

If you have any questions or concerns, please contact your Provider Relations Representative.

Developmental Screening Recommendations

Developmental screening in the first three years of life is a 2017 Quality Incentive Measure chosen by the Oregon Health Authority. Developmental screening is defined by the American Academy of Pediatrics as “the administration of a brief, standardized and validated tool that aids the identification of children at risk for developmental, behavioral or social delays.”*

Furthermore, Federal Bright Futures Recommendations call for children to be screened, using a global developmental screening tool, at three different times in the first three years of life in the context of routine well-child visits or when a concern is raised through standardized developmental surveillance.**

Measure Specifications

Denominator: Children who turn 1, 2 or 3 years of age in the measurement year and had continuous enrollment in the CCO for the 12 months prior to their birthdate in the measurement year

Numerator: Children in the denominator who had a claim with CPT code 96110 in the 12 months preceding the birthday in the measurement year

Exclusions: none; 2017 Benchmark: 60.1%

Developmental Screening Tools

The Oregon Health Authority recommends using one of the following tools:

Ages and Stages Questionnaire, Third Edition, or

Parent’s Evaluation of Developmental Status, with or without the Developmental Milestones